Relation of homocysteinemia to contrast-induced nephropathy in patients undergoing percutaneous coronary intervention

Area of Science:

• Nephrology
• Cardiology
• Biochemistry

Background:

• Contrast-induced nephropathy (CIN) is a significant complication following percutaneous coronary intervention (PCI).
• Hyperhomocysteinemia, characterized by elevated homocysteine levels, is linked to oxidative stress and endothelial dysfunction, mechanisms implicated in CIN.
• The relationship between hyperhomocysteinemia and CIN risk has not been previously established.

Purpose of the Study:

• To investigate the association between hyperhomocysteinemia and the incidence of CIN in patients undergoing PCI.
• To determine if hyperhomocysteinemia is an independent risk factor for CIN.

Main Methods:

• An observational cohort study involving 572 patients undergoing PCI.
• CIN was defined by specific increases in serum creatinine levels 48 hours post-procedure.
• Statistical analyses, including multiple logistic regression, were used to assess the association, adjusting for known risk factors.

Main Results:

• The incidence of CIN was markedly higher in patients with the highest tertile of homocysteine levels (24.2%) compared to lower tertiles (4.7%, 7.3%).
• Patients with CIN exhibited significantly higher homocysteine levels (16.9 ± 4.9 μmol/L) than those without CIN (13.5 ± 4.2 μmol/L).
• Hyperhomocysteinemia was identified as an independent risk factor for CIN (OR 1.70, 95% CI 1.07-2.71, p=0.025), even after adjusting for age, diabetes, and baseline renal function.

Conclusions:

• Hyperhomocysteinemia is independently associated with an increased risk of developing contrast-induced nephropathy in patients undergoing percutaneous coronary intervention.
• Elevated homocysteine levels represent a significant, modifiable risk factor for CIN in this patient population.
• Further research may explore interventions to lower homocysteine levels to mitigate CIN risk.